MADACC Surgical Waiver

Species

Sex of Animal

I, the undersigned, have read and understood this entire page and authorize Milwaukee Area Domestic Animal Control Commission (MADACC) to anesthetize, surgically sterilize, and provide other related medical care the above referenced animal. I agree to pay according to the fee schedule set up by MADACC.

Your animal will receive a small (1/2 inch) green line tattoo as a permanent indication that the animal has had a sterilization surgery. I understand and accept this indication will be placed.

I understand that if I miss my appointment there are NO REFUNDS or RESCHEDULING of appointments once booked and I will forfeit all money paid.

I understand there are medical risks associated with the Procedure, including but not limited to infection, hemorrhage, allergic reaction, anesthetic drug reaction, anesthesia-induced cardiac compromise, and death. I understand that MADACC will perform a physical exam but not perform a comprehensive cardiac exam, other diagnostic tests, and blood-work prior to the Procedure. I understand that there are increased risks due to the fact that MADACC will no perform extensive pre-operative diagnostic evaluations nor continued heart monitoring during this procedure. I further understand that there are additional risks if the pet is not current on recommended vaccines. Pain medication (NSAID) to help control post-op pain will be provided for every animal. Like all medication, NSAIDS can cause side effects. While these side effects are uncommon, when they occur, they can lead to kidney and/or liver damage. I understand the benefits and risks of the medication and will follow the label directions on the dispensed medication.

My animal has pre-existing medical conditions/concerns.

I will hold harmless MADACC, its officers, directors, veterinarians, technicians, volunteers, and agents for any problems experienced by the animal as a result of the Procedure or the above risk factors. If in the course of treatment a condition is discovered that requires medical attention or an additional procedure, such as a hernia repair or the administration of IV fluids, the attending veterinarian may, in his/her absolute discretion, perform such procedure. I consent to these procedures and agree to pay reasonable additional charges if any.

I agree that I will be available by phone all day the day of surgery to speak directly with the veterinarian performing the surgery. If I do not speak directly with the veterinarian prior to surgery, the surgery will not be performed and I will forfeit the fees paid to MADACC. If a situation arises during surgery and I cannot be reached at the phone number above, I authorize the veterinarian to use his/her discretion and clinical judgement as to how to proceed. I understand that MADACC staff will not leave a message, and that I have to be available by phone during the day of the procedure. I agree that I will be financially responsible for any post-operative medical treatment relating to this Procedure or any other unrelated medical problems of my animal.

Arrival for drop off is at 8:00 am and I will plan on being present until 8:45 am. During this time you will join a conference call for the pre-surgical instructions with the Veterinarian. Clients/patients not present for this whole time will not be accepted for surgery. Per the above statement, I understand that my appointment will not be rescheduled and my fee will not be refunded.

I am aged 18 or older and the legal owner of the animal I am contracting medical treatment for: